手足口病患儿肠道病毒检测结果分析
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摘要
目的比较手足口患儿粪便和咽拭子中肠道病毒的载量和检出率。方法收集2013年5月-2013年9月杭州市儿童医院临床诊断手足口病患儿1 117例标本(其中粪便105例,咽拭子1 012例),采用荧光定量RT-PCR方法进行肠道病毒核酸检测,并对其中72例同时留取粪便和咽拭子的患儿样本分别进行阳性率和定量结果 log值配对分析。结果粪便和咽拭子标本肠道病毒总阳性率分别为86.7%、77.3%,差异有统计学意义(χ2=4.92,P=0.027);72例配对标本结果同为阳性的54例,同为阴性的11例,粪便阳性、咽拭子阴性为7例,粪便阴性、咽拭子阳性为0例,差异有统计学意义(Mc Nemar P=0.016);72例配对标本定量结果显示粪便标本中病毒含量高于咽拭子标本(t=6.924,P=0.000)。结论粪便标本中肠道病毒检出率高于咽拭子标本,且病毒载量也高于咽拭子标本。
Objective Virus load and detection rate of enterovirus between stools and pharyngeal swabs of children were analyzed and compared.Methods A total of 1 117 specimens(105 stools specimens and 1012 nasopharyngeal swabs) from the children who were clinically diagnosed with HFMD in Hangzhou Children's Hospital from May to September in 2013 were collected and enterovirus nucleic acid was detectedby fluorescence quantitative reverse transcriptase-polymerase chain reaction(RT-PCR).Moreover,72 of the specimens which contained both stools and pharyngeal swabs were analyzed in pair with positive rate and natural logarithms of quantitative results.Results The positive rate of enterovirus in stool specimens was 86.7%(91/105) while the positive rate of that in the pharyngeal swabs specimens was 77.3%(782/1 012).The difference is statistically significant(χ2= 4.92,P = 0.027);Among the paired 72 specimens,enterovirus was detected positive both in stool specimens and pharyngeal swabs in 54 patients;enterovirus was detected negative in stool specimens and pharyngeal swabs in 11 specimens,while paired specimens of stools in positive and pharyngeal swabs in negative were 7.However,the specimens of enterovirus negative in stool specimen while positive inpharyngeal swabs is zero.The difference was also statistically significant(Mc Nemar P = 0.016);The results showed that the content of enterovirus in stool specimens was higher than that in pharyngeal swabs(t = 6.924,P = 0.000).Conclusion Both the virus load and detection rate of enterovirus in stool specimens are higher than that in pharyngeal swabs.
Objective Virus load and detection rate of enterovirus between stools and pharyngeal swabs of children were analyzed and compared.Methods A total of 1 117 specimens(105 stools specimens and 1012 nasopharyngeal swabs) from the children who were clinically diagnosed with HFMD in Hangzhou Children's Hospital from May to September in 2013 were collected and enterovirus nucleic acid was detectedby fluorescence quantitative reverse transcriptase-polymerase chain reaction(RT-PCR).Moreover,72 of the specimens which contained both stools and pharyngeal swabs were analyzed in pair with positive rate and natural logarithms of quantitative results.Results The positive rate of enterovirus in stool specimens was 86.7%(91/105) while the positive rate of that in the pharyngeal swabs specimens was 77.3%(782/1 012).The difference is statistically significant(χ2= 4.92,P = 0.027);Among the paired 72 specimens,enterovirus was detected positive both in stool specimens and pharyngeal swabs in 54 patients;enterovirus was detected negative in stool specimens and pharyngeal swabs in 11 specimens,while paired specimens of stools in positive and pharyngeal swabs in negative were 7.However,the specimens of enterovirus negative in stool specimen while positive inpharyngeal swabs is zero.The difference was also statistically significant(Mc Nemar P = 0.016);The results showed that the content of enterovirus in stool specimens was higher than that in pharyngeal swabs(t = 6.924,P = 0.000).Conclusion Both the virus load and detection rate of enterovirus in stool specimens are higher than that in pharyngeal swabs.
引文
[1]杨智宏,朱启镕,李秀珠,等.2002年上海儿童手足口病病例中肠道病毒71型和柯萨奇病毒A组16型的调查[J].中华儿科杂志,2005,43(9):648-652.
[2]严秀峰,葛艳玲,谢新宝,等.上海地区重症手足口病住院患儿临床分析[J].中华儿科杂志,2012,50(4):271-275.
[3]吴亦栋,尚世强,陈志敏,等.手足口病病原体流行特征分析及临床意义[J].中华儿科杂志,2010,48(7):535-539.
[4]贾蕾,李爽,李洁,等.手足口病患者不同标本肠道病毒检出率比较[J].中华流行病学杂志,2011,32(5):528.
[5]胡海赟,乔蓉,沈琦,等.2009-2011年上海市手足口病病原学检测及其临床特点分析[J].中华实验和临床病毒学杂志,2012,26(5):341-343.
[6]宋楠,周庆梅,孟丽芳.不同部位样本采集对小儿手足口病咽拭子阳性检出率的影响[J].中国实用护理杂志,2012,28(26):45-46.
[7]Ooi MH,Solomon T,Podin Y,et al.Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease[J].J Clin Microbiol,2007,45(6):1858-1866.
[8]Wang JR,Tsai HP,Chen PF,et al.An outbreak of Enterovirus 71infection in Taiwan,1998.Ⅱ.Laboratory diagnosis and genetic analysis[J].J Clin Microbiol,2000,17(2):91-99.
[9]李亮,汪华,史智扬,等.江苏省手足口病病原阳性检出率相关因素及病原学特征[A].南京医科大学学报:自然科学版,2010,30(1):128-133.
[10]罗旭峰,周涛,刘玉玲,等.79例重症手足口病儿童病原学分析[J].中国实用医药,2012,7(20):22-23.
[11]Landry ML,Fonseca SNS,Cohen S,et al.Fatal Enterovirus type71 infection:rapid detection and diagnosticpitfalls[J].Pediatr Infect Dis J,1995,14(12):1095-1100.
[12]Kung CM,King CC,Lee CN,et al.Differences in replication capacity between enterovirus 71 isolates obtained from patients with encephalitis and those obtained from patients with herpangina in Taiwan[J].J Clin Microbiol,2007,79(1):60-68.
[13]Prim N,Rodriguez G,Margall N,et al.Combining cell lines to optimize isolation of human enterovirus from clinical specimens:Report of25 years of experience[J].J Med Virol,2013,85(1):116-120.
[14]Rotbart HA.Enzymatic RNA amplification of the enteroviruses[J].JClin Microbiol,1990,28(3):438-442.
[15]Volle R,Nourrisson C,Mirand A,et al.Quantitative real-time RTPCR assay for research studies on enterovirus infections in the central nervous system[J].J Virol Methods,2012,185(1):142-148.
[16]Verboon-Maciolek MA,Nijhuis M,van Loon AM,et al.Diagnosis of enterovirus infection in the first 2 months of life by real-time polymerase chain reaction[J].Clin Inf Dis,2003,37(1):1-6.
[17]Yen MH,Tsao KC,Huang YC,et al.Viral load in blood is correlated with disease severity of neonatal coxsackievirus B3 infection:early diagnosis and predict-ing disease severity is possible in severe neonatal enterovirus infection[J].Clin Inf Dis,2007,44(10):78-81.
[18]Chung PW,Huang YC,Chang LY,et al.Duration of Enterovirus shedding in stool[J].J Micmbiol Immunol Infect,2001,34(3):167-170.
[19]李颐,居丽雯,蒋露芳,等.不同病程手足口病患者咽拭、肛拭配对标本肠道病毒检出率的比较[J].中华传染病杂志,2013,31(3):170-172.
[2]严秀峰,葛艳玲,谢新宝,等.上海地区重症手足口病住院患儿临床分析[J].中华儿科杂志,2012,50(4):271-275.
[3]吴亦栋,尚世强,陈志敏,等.手足口病病原体流行特征分析及临床意义[J].中华儿科杂志,2010,48(7):535-539.
[4]贾蕾,李爽,李洁,等.手足口病患者不同标本肠道病毒检出率比较[J].中华流行病学杂志,2011,32(5):528.
[5]胡海赟,乔蓉,沈琦,等.2009-2011年上海市手足口病病原学检测及其临床特点分析[J].中华实验和临床病毒学杂志,2012,26(5):341-343.
[6]宋楠,周庆梅,孟丽芳.不同部位样本采集对小儿手足口病咽拭子阳性检出率的影响[J].中国实用护理杂志,2012,28(26):45-46.
[7]Ooi MH,Solomon T,Podin Y,et al.Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease[J].J Clin Microbiol,2007,45(6):1858-1866.
[8]Wang JR,Tsai HP,Chen PF,et al.An outbreak of Enterovirus 71infection in Taiwan,1998.Ⅱ.Laboratory diagnosis and genetic analysis[J].J Clin Microbiol,2000,17(2):91-99.
[9]李亮,汪华,史智扬,等.江苏省手足口病病原阳性检出率相关因素及病原学特征[A].南京医科大学学报:自然科学版,2010,30(1):128-133.
[10]罗旭峰,周涛,刘玉玲,等.79例重症手足口病儿童病原学分析[J].中国实用医药,2012,7(20):22-23.
[11]Landry ML,Fonseca SNS,Cohen S,et al.Fatal Enterovirus type71 infection:rapid detection and diagnosticpitfalls[J].Pediatr Infect Dis J,1995,14(12):1095-1100.
[12]Kung CM,King CC,Lee CN,et al.Differences in replication capacity between enterovirus 71 isolates obtained from patients with encephalitis and those obtained from patients with herpangina in Taiwan[J].J Clin Microbiol,2007,79(1):60-68.
[13]Prim N,Rodriguez G,Margall N,et al.Combining cell lines to optimize isolation of human enterovirus from clinical specimens:Report of25 years of experience[J].J Med Virol,2013,85(1):116-120.
[14]Rotbart HA.Enzymatic RNA amplification of the enteroviruses[J].JClin Microbiol,1990,28(3):438-442.
[15]Volle R,Nourrisson C,Mirand A,et al.Quantitative real-time RTPCR assay for research studies on enterovirus infections in the central nervous system[J].J Virol Methods,2012,185(1):142-148.
[16]Verboon-Maciolek MA,Nijhuis M,van Loon AM,et al.Diagnosis of enterovirus infection in the first 2 months of life by real-time polymerase chain reaction[J].Clin Inf Dis,2003,37(1):1-6.
[17]Yen MH,Tsao KC,Huang YC,et al.Viral load in blood is correlated with disease severity of neonatal coxsackievirus B3 infection:early diagnosis and predict-ing disease severity is possible in severe neonatal enterovirus infection[J].Clin Inf Dis,2007,44(10):78-81.
[18]Chung PW,Huang YC,Chang LY,et al.Duration of Enterovirus shedding in stool[J].J Micmbiol Immunol Infect,2001,34(3):167-170.
[19]李颐,居丽雯,蒋露芳,等.不同病程手足口病患者咽拭、肛拭配对标本肠道病毒检出率的比较[J].中华传染病杂志,2013,31(3):170-172.